SLR - March 2018 - Stephanie P. Means

In-Hospital Complications Following Ankle Arthrodesis Versus Ankle Arthroplasty

Reference: Odum S, Van Doren BA, Anderson RB, Hodges Davis W. In-Hospital Complications Following Ankle Arthrodesis Versus Ankle Arthroplasty. The Journal of Bone and Joint Surgery. 2017 Sept 6;99(17):1469–75.

Scientific Literature Review

Reviewed By: Stephanie P. Means, DPM
Residency Program: Hennepin County Medical Center, Minneapolis, MN

Podiatric Relevance: As surgical technique and implants themselves have improved, more podiatric surgeons are turning to total ankle arthroplasty (TAA) as an alternative to arthrodesis in patients with severe, end-stage ankle arthritis. This study compares the U.S. national rate of perioperative complications in statistically matched patients undergoing either TAA or ankle arthrodesis.

Methods: This therapeutic level III study statistically matched 1,574 patients who underwent total ankle arthroplasty with 1,574 patients who underwent ankle arthrodesis. Perioperative complications were subdivided into four categories: inpatient death, major complications, minor complication or no complications. A minor complication included phlebitis, venous embolism, pulmonary insufficiency, emphysema from the procedure, hemorrhage, hematoma, seroma, a nonhealing wound and unspecified complications. A major complication included cardiac arrest, vascular complication, pulmonary embolism, ventilator-associated pneumonia, shock, wound disruption, retained surgical item, infected seroma, prosthetic mechanical complication, breakage or dislocation, periprosthetic fracture or infection and any other complication involving the prosthesis. Each TAA patient was matched with one ankle arthrodesis patient using the Mayo Clinic greedy matching SAS micro with matching based on age, sex, race, hospital location/teaching status, year of surgery, comorbidities, adjunctive foot/ankle procedures and surgical indication.

Results: A major in-hospital complication occurred in 8.5 percent of the ankle arthrodesis group, compared to 5.3 percent in the TAA group. Minor complication was found in 4.7 percent of the arthrodesis group, compared to 5.9 percent of the TAA group. There were no instances of in-hospital death. Once case mix was adjusted for, it was concluded ankle arthrodesis was 1.8 times more likely to incur a major complication, but 29 percent less likely to incur a minor complication when compared to TAA. It was also determined that patient age and health status had significant, independent effects on the risks of major complications. Both patients less than 67 years old and those in poor health had a higher risk of major complication. The risk of minor complication increased with the number of patient comorbidities.

Conclusions: According to this study, total ankle arthroplasty is a safe alternative to arthrodesis when performed in an in-hospital environment. Although minor complications may be slightly higher in the TAA group, major complications are 1.8 times less likely to occur in this group. With more podiatric surgeons venturing into total ankle arthroplasty in recent decades, it is important to have a firm understanding of the complications that accompany the procedure. This article well defines major and minor complications of TAA and ankle arthrodesis and explores their likelihood. The information gleaned from this study can be effectively be incorporated in the preoperative discussion with patients, offering them a comprehensive knowledge of potential risks of either procedure.  

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